GI Exam

A client asks, "Why do some foods, like corn, come out undigested in my feces?" Which is the nurse's best response?

Corn is high in cellulose, which is an insoluble fiber that the body cannot digest.

When is digital removal of feces contraindicated?

Digital removal of feces is contraindicated in the following conditions: • For most clients with cardiac conditions. • After reproductive surgery, abdominoperineal repair, rectal surgery, colostomy, or genitourinary surgery. • For clients who are receiving radioactive isotope therapy or perineal perfusion of anticancer drugs. • For clients who have a bleeding tendency, especially in the rectal or vaginal area. • For pregnant women.

Which of the following medications are used to treat nausea and vomiting and also motion sickness? Select all that apply.

Dimenhydrinate, meclizine

A nurse follows a physician's order to administer an oil-retention enema to a constipated adult client. Which action is a recommended guideline for this procedure?

Direct the rectal tube at an angle pointing toward the umbilicus.

The nurse has assessed 50 mL of gastric residual after completing a tube feeding. What is the appropriate nursing action?

Document the assessment finding.

A nurse is providing discharge instructions for a client with a new colostomy. Which is a recommended guideline for long-term ostomy care?

Drink at least 2 quarts (1.9 L) of fluids, preferably water, daily.

A nurse is caring for a client with diarrhea. Which intervention can help provide relief to a client with diarrhea?

Encourage a clear liquid diet

The nurse is creating a plan of care for an older adult client at risk for constipation. Which intervention by the nurse will decrease this risk?

Encourage physical activity to improve bowel regularity.

You are preparing to administer a first time dose of metaclopramide to your client. Which of the following symptoms should you monitor the client for?

Facial dyskinesia

Why is it necessary for a client with gastroesophageal reflux disease (GERD) to follow a strict diet?

GERD is aggravated if a client has chocolate, peppermint, spicy foods, coffee, tomato products, citrus fruits, or fried foods. Intake of alcohol and overeating exacerbate the condition. Hot or cold liquids intensify the sensation. Hence, clients with GERD should follow a strict diet.

A client tells the nurse that he takes laxatives every day but is still constipated. The nurse's response is based on which reasoning?

Habitual laxative use is the most common cause of chronic constipation.

Which is an appropriate intervention when unexpected situations occur during the administration of a tube feeding?

If the tube becomes clogged when aspirating contents, use warm water and gentle pressure to remove the clog.

The nurse notices thick mucus that is obstructing the lumen of a client's nasogastric tube. What is the appropriate nursing action?

Increase suction momentarily to clear the tubing.

A client is on bed rest and an enema has been prescribed. Which precaution(s) will be taken by the nurse to facilitate the client's comfort and participation? Select all that apply.

Instill the fluid slowly. Place the client in the Sims position. Apply lubricant to the rectal tip. Raise the client's buttocks before inserting the enema. Maintain equal pressure on the enema until it is removed from the rectum.

Which statement accurately describes a step in the administration of a tube feeding?

Intermittent feedings use gravity for instillation or a feeding pump to administer the formula over a set period of time.

What do long, thin, pencil-like stools indicate?

Long, thin, pencil-like stools suggest a narrowing of the rectum or anal opening, which could be caused by a mass, impaction, or tumor.

A nurse prepares to insert a nasointestinal tube to provide nutrition to a client. Which step should be performed as part of this procedure?

Measure the tube from the tip of the nose to the ear lobe and from the ear lobe to the xiphoid process.

Which of the following would most likely be used to treat a patient with an H. pylori infection?

Pantoprazole

Tube feedings are given to a client after an oral surgery. The nurse manages tube feedings to minimize the risk of aspiration. Which measures should the nurse include in the care plan to reduce the risk of aspiration?

Place the client in a semi-Fowler position during and 30 to 60 minutes after an intermittent feeding.

A nurse is documenting the eating habits of a client who wants to include more fiber in the diet. Which is the best statement to include?

Plan to eat a snack of fruit twice per day

What is the correct order of auscultation when listening to bowel sounds?

RLQ, RUQ, LUQ, LLQ; Inspect, Auscultate, Percuss, palpate.

The nurse is inserting a nasogastric tube and meets resistance with insertion. Which nursing action is most appropriate?

Rotate the tube slightly and ask the client to swallow.

A client requires gastric decompression. Which supply does the nurse anticipate gathering?

Salem Sump

You are caring for a client whose code status has been changed to Do Not Resuscitate (DNR). As you assess their lung sounds, you note the client to have labored breathing and very "wet" lung sounds. When you look over the prn orders for your client, which of the following would you likely see written by the physician?

Scopolamine hydrobromide

The nurse is teaching a client how to change an ostomy appliance. After removing the existing pouch, which action will the nurse teach next?

Shower, bathe, or wash peristomal area with mild soapy water.

The nurse is placing a nasogastric tube when the client becomes short of breath, coughs, and has difficulty breathing. What is the priority nursing action?

Stop placement and assess for signs of respiratory distress.

The student nurse is administering a large-volume enema to a client. The client reports abdominal cramping. What should the student nurse do first?

Stop the administration of the enema momentarily.

A hospitalized client has been experiencing abdominal pain in recent days and has developed a noticeably distended and firm abdomen. The client states feeling constipated, but a review of the client's medical record reveals that the client has had several episodes of diarrhea over the past 72 hours. How should the nurse best interpret these events?

The client may have a fecal impaction in which liquid stool bypasses the impacted stool.

A 5-year-old client has a gastrointestinal infection. His mother plans to send him to school tomorrow. The school nurse knows that which nursing outcome is most important to include in the care plan of the client?

The client will demonstrate good health practices to prevent spread of infection.

What are the nursing considerations to be followed when preparing a client for a cholecystogram?

The nursing considerations when preparing a client for a cholecystogram include instructing the client to avoid fat-free foods the night before the procedure, teaching the client how to take radiopaque dye by mouth, instructing the client to avoid eating for 12 hours after taking the dye, and to avoid smoking, and administering an enema if necessary.

The nurse assesses that the drainage holes of a client's nasogastric tube are adhering to the gastric mucosal wall. What is the appropriate nursing action?

Turn off suction momentarily and reposition the client.

Vomiting is dangerous and needs to be prevented in what situations?

Vomiting is dangerous and needs to be prevented in clients who have had recent abdominal surgery or delicate eye surgery (they may incur an injury as a result of the violent action of vomiting) and also in those who have ingested a caustic substance (they can experience additional injury by vomiting).

The nurse is flushing a client's feeding tube with 50 mL of water after giving medications through it. When the client asks, "Why are you doing that?" what is the appropriate nursing response?

Water helps keep the feeding tube free from obstruction

Which factor is related to developmental changes in bowel habits for older adult clients?

Weakened pelvic muscles lead to constipation.

What are the nursing considerations to be followed when caring for a client after a liver biopsy?

When caring for a client after a liver biopsy, the nurse should ensure that the client is positioned on the right side, pressure is applied on the biopsied site for 4 to 6 hours, vital signs are recorded periodically, and the client is observed for signs for bleeding.

Why would constipation be misinterpreted as diarrhea?

With an obstruction/blockage/constipation liquid stool can seep around the hardened stool and give the appearance of diarrhea. Other signs of constipation would include: abdominal pain radiating to the back, nausea & vomiting (possibly emesis of feces), firm area in one or more of the abdominal quadrants. Sometimes, when a client has been constipated for a long time, the client may begin passing liquid stool around an obstructive stool mass (encopresis), a phenomenon sometimes misinterpreted as diarrhea. The liquid stool results from dry stool that stimulates nerve endings in the lower colon and rectum, which increases peristalsis. The increased peristalsis sends watery feces from higher in the bowel than the retained stool.

Which client is most likely to require interventions in order to maintain regular bowel patterns?

a client whose neuropathic pain requires multiple doses of opioids each day

What is the most reliable method for verifying the correct placement of a nasogastric tube?

a radiographic exam that can position

After the administration of a nasointestinal feeding tube, a patient reports gas, abdominal pain, and dizziness. What do these symptoms indicate?

a type of dumping syndrome

The risk for developing colorectal cancer during one's lifetime is 1 in 19. Nurses play an integral role in the promotion of colorectal cancer screening. What are risk factors for colorectal cancer? Select all that apply.

age 50 and older a positive family history a history of inflammatory bowel disease

Drugs that neutralize gastric acid and protect the mucosal lining are called

antacid

The nurse is caring for an elderly client with Alzheimer disease. The client has just returned to the unit to begin supplemental tube feedings through a gastrostomy tube. The nurse should be most concerned with the potential for:

aspiration

A client is preparing for a fecal occult blood test. What teaching will the nurse provide regarding vitamin C three days before testing?

avoid more than 250mg

When the nurse performs a Hemoccult test on a stool specimen, blood in the stool will change the color on the test paper to:

blue

The nurse is educating a new colostomy client on gas-producing foods. Which food is a gas-producing food the client may choose to avoid?

brussell sprouts

A client scheduled for a colonoscopy is scheduled to receive a hypertonic enema prior to the procedure. A hypertonic enema is classified as which type of enema?

cleansing enema

The nurse should begin the process of removing a client's nasogastric (NG) tube by:

confirming the physicians order to remove the tube

A client who has been receiving tube feedings is beginning to take in oral food and fluids. To facilitate weaning the client from tube feedings, which delivery method does the nurse anticipate?

cyclic feedings

A client's recent diagnosis of colorectal cancer has required a hemicolectomy (removal of part of the bowel) and the creation of a colostomy. The nurse would recognize that the client's stoma is healthy when it appears what color?

dark pink and moist

A nurse is assessing the stoma of a client with an ostomy. What would the nurse assess in a normal, healthy stoma?

dark red and moist

The nurse is assessing a client with abdominal complaints. The nurse performs deep palpation of the abdomen for which reason?

detect abdominal masses

The nurse has assessed 100 mL of gastric residual after completing a tube feeding. What is the appropriate nursing action?

document the assessment findings

A client who has been on a medication that caused diarrhea is now off the medication. What could the nurse suggest to promote the return of normal flora?

eating fermented products, such as yogurt

An older adult resident of a long-term care home has been experiencing diarrhea for the past two days as a result of an influenza outbreak at the facility. The nurse at the care home should be aware that older adults who experience diarrhea are at increased risk of what health problem?

electrolyte imbalance

Osmotic agents, stool softners, and saline laxatives are used for irritable bowel syndrome.

false

When preparing the client's polyethylene glycol electrolyte solution, you may mix it with Gatorade or clear soda to make it more palatable and tolerable.

false

A client with significant nutritional deficits is being placed on tube feedings. The client's condition indicates that he will need these feedings for a minimum of 6 to 8 weeks and possibly longer. The nurse would anticipate the use of which tube?

gastostomy

Which type of feeding tube would be most appropriate for a client requiring enteral feeding for a long period of time?

gastrostomy tube

What are two essential techniques when collecting a stool specimen?

hand hygiene and wearing gloves

A client with nonhealing wounds requires a feeding tube. Which type of formula does the nurse anticipate will be ordered?

high protein

are used for prophylaxis of stress ulcers.

histamine h2 antagonist

A client with terminal cancer is taking high doses of a narcotic for pain. Which comfort measures should the nurse teach the client's family regarding how to manage elimination care?

increase fiber in diet

A client is receiving enteral nutrition via an unvented nasogastric tube. Which suction settings will most likely prevent the tube from adhering to the wall of the client's stomach?

intermittent suction at 40 to 60 mmHg

A client's last bowel movement was 4 days ago and oral laxatives and dietary changes have failed to prompt a bowel movement. How should the nurse position the client in anticipation of administering a cleansing enema?

left side lying

The type of stool that will be expelled into the ostomy bag by a client who has undergone surgery for an ileostomy will be:

liquid consistency

The antidiarrheal drugs are administered cautiously in clients with severe hepatic impairment. The following medications are commonly used for treatment of diarrhea: Select all that apply:

loperamide, bismuth, noxylate with atropine

A nurse is administering a prescribed solution of cottonseed oil to a client during an enema. What is the outcome of the use of cottonseed?

lubricates and softens stool

The following foods are a part of a client's daily diet: high-fiber cereals, fruits, vegetables, ten 8-oz glasses (2,500 mL) of fluids. What would the nurse tell the client to change?

nothing this is a good diet

Digital rectal examination confirms that a client has an impaction, and an enema solution has been ordered to lubricate the stool and intestinal mucosa without distending the intestine. What solution best meets this client's needs?

oil

A client with colorectal cancer reports constipation. Which signs or symptoms accompany constipation?

pain on defecation

The nurse is caring for a client who has Crohn's disease with impaired absorption and now requires tube feeding. Which type of formula does the nurse anticipate will be ordered?

partially hydrolyzed

The nurse is administering a rectal suppository. How far will the nurse insert the suppository?

past the internal sphincter

What is the most critical component of an enteral feeding formula?

protein

Nursing students are reviewing information about the advantages and disadvantages of the different types of feeding tubes. The students demonstrate understanding of the information when they identify which as an advantage of a nasointestinal feeding tube?

reduced danger of aspiration

A client has been prescribed a nasointestinal tube. Which is the key advantage of a nasointestinal tube over a nasogastric tube?

reduces danger of aspiration

The nurse is caring for an older adult client with diarrhea. Which assessment finding requires immediate nursing intervention?

skin tugor response 5 seconds

A client receiving tube feedings has a gastric residual of 500 mL. Which nursing intervention is most appropriate?

stop the infusion

A nurse is caring for a 65-year-old woman who has undergone a hernia operation. The client receives morphine via patient-controlled anesthesia for postoperative pain. The client also receives sulfamethoxazole-trimethoprim every 12 hours to treat a urinary tract infection, and an iron supplement for anemia. The client is on mobility restrictions because of the narcotics. The client explains that while she usually passes stool once per day, she has passed stool four times today. The health care provider has diagnosed diarrhea. What is most likely contributing to this outcome?

sulfamethoxazole-trimethoprim

A nurse is checking the placement of a nasogastric tube in a client. Which is the most accurate technique for checking tube placement?

testing the pH of the aspirated liquid

The nurse is checking placement of a nasogastric tube that has been in place for 2 days. The tube is draining green aspirate. What does this color of aspirate indicate?

the tube is in the stomach

A client with no significant medical history reports constipation for the past week. Which assessment information will the nurse collect? Select all that apply.

whether the client is taking new medication the client's normal bowel habits if the client feels a sensation of rectal fullness if the client has used laxatives in the past

The nurse is preparing to administer a client's tube feeding. How should the nurse position the client prior to beginning the infusion?

with the head of the bed at least 30 to 45 degrees

A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement?

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day."

The nurse in an outpatient provider's office is caring for a client with persistent flatus. Which client teaching will the nurse provide as to why some foods cause flatus?

"Certain vegetables can cause flatus, as they are more difficult to digest."

A nurse is caring for a client whose primary care provider has written an order for "enemas until clear." Which explanation to the client about this procedure is correct?

"I will administer enemas until the enema return is without stool."

A nurse is documenting the appearance of feces from a client with a permanent ileostomy. Which scenario would she document?

"Ileostomy bag half filled with liquid feces."

An older adult client tells the nurse, "I give myself a mineral oil enema every day." What is the appropriate nursing response?

"Mineral oil enemas can interfere with absorption of fat-soluble vitamins."

The nurse is teaching a client with rectal bleeding about fecal occult blood test (FOBT) testing supplies. What teaching will the nurse provide?

"This test detects heme, a type of iron compound in blood in the stool."

The nurse has provided instructions to a client having a fecal immunochemical test (FIT). The client states, "I am menstruating right now. Is it okay to still do the test?" What is the best response by the nurse?

"Wait to do the test 3 days after your finish menstruating."

A client calls the physician's office and reports a case of diarrhea. The nurse recommends that the client rest the bowel and drink clear fluids but avoid foods for what time period?

12 to 24 hours

A nurse is checking the placement of a nasogastric tube and aspirates fluid to test the pH. Which result would the nurse interpret as indicating that the tube is in the stomach?

3

A nurse administers a continuous tube feeding via an NG tube. The nurse must check for residual every:

4 to 6 hours

A client has a Salem Sump tube inserted for gastric decompression. The physician orders the tube to be attached to low intermittent suction. The nurse attaches the tube to the wall suction unit. Which setting would be appropriate?

45 mmHg

A client has been receiving feeds for the past 2 weeks during recovery from a severe stroke. The care team has discussed the client's nutritional needs with the family, and they have collectively decided to replace the client's nasogastric (NG) tube with a percutaneous endoscopic gastrostomy (PEG) tube. What advantage does a PEG tube hold over an NG tube?

A PEG tube can be used for longer-term feeding, but an NG tube can only be used for shorter-term feeding.

What is a Hemoccult test? How do you know if it is positive? What would cause a false positive?

A simple test that determines the presence of occult blood in the stool is the Hemoccult or guaiac test. A positive result indicates that the client is bleeding or has recently bled from somewhere in the gastrointestinal tract. If the guaiac test is positive, the developer turns the stool sample blue. (Guaiac by the way is a substance from a plant that is used to coat the test cards.) False positive could be caused by: Large amounts of rare red meat, radishes, tomatoes, beets, horseradish, or some melons -cantaloupe. A false NEGATIVE could be caused by high doses of vitamin C (>250 mg per day).

What equipment is kept at the bedside following oral surgery?

After oral surgery, there should be equipment for suctioning, administration of oxygen, and tracheostomy at the client's bedside. If the client does not have a tracheostomy, a tracheostomy tray must be nearby for emergency use because respiratory distress or airway obstruction requires immediate attention.

The nurse is preparing to insert a nasogastric tube into a client who is very anxious. Which nursing intervention is appropriate?

Agree upon a hand signal for when the client needs a pause.

The nurse is caring for a client with a stoma that is pink in color and dry. Which action will the nurse take?

Apply petroleum-based ointment.

A nurse inserts a rectal suppository into a middle-age female client. The client says that she has an urge to expel the suppository instantly. Which action should the nurse perform?

Ask the client to contract the gluteal muscles.

What is the type of enema used to introduce contrast solution into the bowel for a radiographic procedure? What is a complication the nurse should monitor for in the client afterwards? What nursing intervention(s) could be applied to prevent this complication?

Barium Enema; constipation; hydration: IVF, encourage po intake & also ambulation; Some clients develop a fecal impaction after a barium enema; the client is unable to pass stools because of impaction caused by retained barium. Digital removal of impacted stool, (manual disimpaction) may be required to relieve this condition and requires a healthcare provider's order.

Which is an accurate step when removing a nasogastric tube?

Before removing the tube, discontinue suction and separate the tube from suction.

An older adult woman who is incontinent of stool following a cerebrovascular accident will have which nursing diagnosis?

Bowel Incontinence related to loss of sphincter control, as evidenced by inability to delay the urge to defecate